scholarly journals Impact of HFNC application on mortality and intensive care length of stay in acute respiratory failure secondary to COVID-19 pneumonia

Heart & Lung ◽  
2021 ◽  
Vol 50 (3) ◽  
pp. 425-429
Author(s):  
İsmet Sayan ◽  
Mustafa Altınay ◽  
Ayşe Surhan Çınar ◽  
Hacer Şebnem Türk ◽  
Nebia Peker ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Acute Respiratory Failure

scholarly journals High flow nasal oxygen in patients with COVID-19 associated acute respiratory failure

2020 ◽  
Author(s):  
Ricard Mellado Artigas ◽  
Bruno L. Ferreyro ◽  
Federico Angriman ◽  
María Hernández-Sanz ◽  
Egoitz Arruti ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Acute Respiratory Failure ◽  
Unit Length ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Intensive Care Unit Length ◽  
Adult Patients

Abstract Purpose Whether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high flow nasal oxygen on ventilator free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19. Methods We conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units. Main exposure was the use of high flow nasal oxygen (conservative group), while early invasive mechanical (within the first day of critical care admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. Intensive care unit length of stay and all-cause in hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding. Results A total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days), and a reduction in intensive care unit length of stay (mean difference: -8.2 days; 95% CI -12.7 to -3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64). Conclusions The use of high flow nasal oxygen upon intensive care admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in intensive care unit length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

Comparative study between noninvasive positive pressure ventilation and invasive mechanical ventilation in patients with respiratory failure

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed N Al Shafi'i ◽  
Doaa M. Kamal El-din ◽  
Mohammed A. Abdulnaiem Ismaiel ◽  
Hesham M Abotiba
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Positive Pressure Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Noninvasive Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Significant Difference

Abstract Background Noninvasive positive pressure ventilation (NIPPV) has been increasingly used in the management of respiratory failure in intensive care unit (ICU). Aim of the Work is to compare the efficacy and resource consumption of NIPPMV delivered through face mask against invasive mechanical ventilation (IMV) delivered by endotracheal tube in the management of patients with acute respiratory failure (ARF). Patients and Methods This prospective randomized controlled study included 78 adults with acute respiratory failure who were admitted to the intensive care unit. The enrolled patients were randomly allocated to receive either noninvasive ventilation or conventional mechanical ventilation (CMV). Results Severity of illness, measured by the simplified acute physiologic score 3 (SAPS 3), were comparable between the two patient groups with no significant difference between them. Both study groups showed a comparable steady improvement in PaO2:FiO2 values, indicating that NIPPV is as effective as CMV in improving the oxygenation of patients with ARF. The PaCO2 and pH values gradually improved in both groups during the 48 hours of ventilation. 12 hours after ventilation, NIPPMV group showed significantly more improvement in PaCO2 and pH than the CMV group. The respiratory acidosis was corrected in the NIPPV group after 24 hours of ventilation compared with 36 hours in the CMV group. NIPPV in this study was associated with a lower frequency of complications than CMV, including ventilator acquired pneumonia (VAP), sepsis, renal failure, pulmonary embolism, and pancreatitis. However, only VAP showed a statistically significant difference. Patients who underwent NIPPV in this study had lower mortality, and lower ventilation time and length of ICU stay, compared with patients on CMV. Intubation was required for less than a third of patients who initially underwent NIV. Conclusion Based on our study findings, NIPPV appears to be a potentially effective and safe therapeutic modality for managing patients with ARF.

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